(2023) CPT Code 93010 | Description, Guidelines, Reimbursement, Modifiers & Examples
CPT code 93010 will be billed for service when the patient is monitored to record the heart’s electrical activity by applying multiple electrodes on the chest. Read on for a further summary of CPT 93010.
Summary
These electrodes are joined with ECG machines by lead wires. Heart activity will be interpreted, measured, and printed on the page.
Impulses will show how fast blood flows, heart rhythms, strength, and timing of impulses from one part to another part of the heart.
CPT code 93010 service includes technical and professional components, While CPT 93005 reports for technical services only.
In contrast, CPT code 93010 comprises professional services only.
Electrocardiogram (CPT code 93010) (EKG or ECG) performs to monitor heart rate, conduction, and rhythm. The following is the list of reasons when EKG performs by the physician:
Evaluation for irregular heartbeats
- To find the reason for chest pain
- To identify the issues related to the heart like shortness of breath, unbearable chest pain, dizziness, fainting.
- To check the Pacemaker whether they are functional or not
- Pre and post evaluation of heart before any surgery or procedures or other heart conditions like Myocardial infarction, endocarditis, severe heart attack, to determine whether Medicine is working effectively or not, to trace any abnormal finding during the physical exam.
There are the following conditions and factors that will influence the ECG (CPT 93010) results, such as:
- Accumulation of fluid in the body
- Obesity, drugs before the test, pregnancy, smoking, size, and locations of the heart
- Chemical imbalance in the body, such as magnesium, potassium, and calcium.
CPT Code 93010 | Description
CPT code 93010 will be billed by the physician when Electrocardiogram or routine ECG performs with at least twelve leads, including the interpretation and report only.
CPT Code 93010 | Reimbursement
A maximum of five units of CPT 93010 is allowed to bill on the same day.
In contrast, a maximum of three times are allowed when documentation supports the medical necessity of CPT 93010.
The CPT 93010 cost and RUVS are as follows when performed in the facility, it will be $8.87 and 0.25623, respectively.
In contrast, non-facility will be $8.87 and 0.25623, respectively.
Modifiers
Modifier 25 will be appended with Evaluation and Management (E/M) CPT codes when performed in conjunction with CPT 93010 on the same day.
For example, the patient presented to the office for intermittent chest pain for three days.
The physician prescribed some medicines and ordered EKG to confirm whether there were any heart-related issues.
Therefore, no modifier is required when billed with CPT 93010. The E/M CPT code bills with modifier 25.
While modifier 59 is appropriate to attach with CPT 93010 as the NCCI bundle exists for this CPT with E/M or check with payer-specific guidelines if the modifier is needed or not.
Modifier 26 indicates the professional services or equipment.
It does not apply with CPT 93010 when the physician performs EKG in a hospital or does not own the equipment used in of Cervical spine or employee in the facility.
In comparison, modifier TC indicates technical components such as machinery used in EKG.
It would be reported by Hospital or third party who owned the equipment.
If EKG (CPT 93010) performs limited by the physician, it is appropriate to report with modifier 52.
If EKG (CPT 93010) is repeated on the same day by the same physician, it is appropriate to add a modifier 76.
In contrast, modifier 77 will be applicable when the different physician does EKG CPT 93010 on the same day.
The following includes medical coding and billing guidelines for CPT 93010:
CPT code 93010 service includes separate written medical and signed reports, order of service, and documentation that should support this service and medical necessity.
If Echocardiography (CPT 93303 – 93350) performs in combination with CPT 93010, then CPT codes (93303-93350) are separately reportable without any modifier requirements according to NCCI.
If CPT 93010 performs in conjunction with the Intracardiac ischemia monitoring system (CPT codes (0525T-0532T).
Modifier 59 will be added with CPT 93010 and allowed to be billed together on the same service date.
Suppose Acoustic cardiography (93799) renders with EKG CPT 93010. Then it should be separately reportable without any modifier.
CPT 93010 claims globally without any TC and 26 modifiers.
If the only professional component did by the physician, then it is appropriate to report CPT code 93010 instead of CPT 93000.
In contrast, for the technical component bill, solely the CPT code 993005.
There is a separate ECG code (93042) for 1-3 Leads while CPT 93010 for at least 12 leads.
If both services perform simultaneously, modifier 59 appropriates with the CPT 93010.
Suppose CPT 93010 service performs in the Emergency department (CPT code 99281-99285) or Critical care codes (99291, 99292).
In that case, the only interpretation of an ECG report (CPT code 93010) will be considered as part of E/M and billed separately.
If CPT 93010 performs with any surgical procedure, Whether the service is minor or significant, it is not a separately payable service.
It will be only payable when rendered for an unrelated condition.
The patient’s current condition should reflect the medical necessity of service with appropriate ICD 10 codes.
ICD 10 codes must be related to heart conditions like severe chest pain, dizziness, shortness of breath, etc.
The most common ICD 10 codes are Z82.49, R07.9, I10, I25.10, R94.31, R00.0, R55, etc.
Billing Examples
The following are examples of CPT 93010 when it is used to bill insurance.
Example 1
A 38-year-old male presents to the office with a chief complaint of dizziness.
The patient reports vertigo began one day ago. Vertigo began while at home when he stood up.
The patient describes the course of vertigo as abrupt, worsens by standing, head movement, movement, breathing, associated with nausea, vomiting, and gait instability, and dizziness is currently 6/10.
Vertigo is not associated with a vision change. He is morbidly obese and has a higher risk of heart disease.
The physician ordered multiple diagnostic tests ECG, CMP, CBC CT, MRI, and X-ray of head and spine.
Example 2
A 30-year-old female presents to the emergency department with no PMH is coming in for intermittent episodes of chest pain that exacerbates by left-arm movement but are non-exertional.
Differential includes, but is not limited to MSK-related pain/costochondritis/ ACS Pt is very well appearing with routine physical exam and vitals.
She is not having any pain right now. Given the positional nature of chest pain, I suspect musculoskeletal cause.
The patient was not getting better by medication.
Physicians ordered a CT chest and EKG to confirm that the heart functioned correctly.
Example 3
A forty-six-year-old female presents to the emergency department with PMH of hypertension and a family history of heart disease, heart murmur, LBBB dx 1 year ago, migraines, tested positive for COVID 1 month ago.
The patient does not receive the vaccine for COVID. She presents to ED c/o constant lip-tingling, lightheadedness, left-sided chest discomfort since yesterday afternoon, and woke this morning with the same symptoms, she also developed left upper extremity tingling and bilateral hand tingling.
PT Denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms.
The patient has a strong family history of heart disease—the physician plans to do labs, EKG, X-ray, CT, and chest MRI.
Example 4
A 27-year-old female presents to the emergency department with PMH Systolic/Diastolic CHF (EF <15% 7/23/21, s/p AICD), COVID x2, s/p TAVR, CAD, CKD, PAD, hypothyroidism for shortness of breath.
He has developed progressively worsening shortness of breath for four days.
He noticed worsening SOB laying on his right side and with exertion.
He takes his vitals daily and weighs himself daily.
He typically weighs 171 lbs but has seen a 3.5 lb increase in his weight to 174.5 lbs over this past week that prompted him to take one dose of alprazolam 30mg.
Physicians ordered a CT chest and EKG to confirm that the heart functioned correctly.
Example 5
A 51-year-old female presents to the emergency with syncope. The patient applies a nicotine patch earlier.
The patient had a brief episode of feeling hot, numbness, and tingling in her b/l hands, “gas discomfort” in her stomach, and headache.
When she tried to get up, she lost consciousness(witnessed by her partner, who I spoke to for more history).
Partner states she was only out for a few seconds before perking up to routine.
Pt states she has had episodes like this in the past but several years ago—no known cardiac history.
Physicians plan to order CBC, CMP, mg, phos, trop, EKG, Tylenol, Pepcid, and Zofran.
EKG: Normal sinus rhythm. 70 bpm. No ST elevation or T wave inversions.
CXR: My interpretation showed no acute abnormalities.
